Sec. 38a-504. (Formerly Sec. 38-262i). Mandatory coverage for treatment of tumors and leukemia. Mandatory coverage for reconstructive surgery, prosthesis, chemotherapy and wigs. Mandatory coverage for
Sec. 38a-504. (Formerly Sec. 38-262i). Mandatory coverage for treatment of
tumors and leukemia. Mandatory coverage for reconstructive surgery, prosthesis,
chemotherapy and wigs. Mandatory coverage for breast reconstruction after mastectomy. (a) Each insurance company, hospital service corporation, medical service
corporation, health care center or fraternal benefit society which delivers or issues for
delivery in this state individual health insurance policies providing coverage of the type
specified in subdivisions (1), (2), (4), (10), (11) and (12) of section 38a-469, shall provide
coverage under such policies for the surgical removal of tumors and treatment of leukemia, including outpatient chemotherapy, reconstructive surgery, cost of any nondental
prosthesis including any maxillo-facial prosthesis used to replace anatomic structures
lost during treatment for head and neck tumors or additional appliances essential for
the support of such prosthesis, outpatient chemotherapy following surgical procedure
in connection with the treatment of tumors, and a wig if prescribed by a licensed oncologist for a patient who suffers hair loss as a result of chemotherapy. Such benefits shall
be subject to the same terms and conditions applicable to all other benefits under such
policies.
(b) Except as provided in subsection (c) of this section, the coverage required by
subsection (a) of this section shall provide at least a yearly benefit of five hundred dollars
for the surgical removal of tumors, five hundred dollars for reconstructive surgery, five
hundred dollars for outpatient chemotherapy, three hundred fifty dollars for a wig and
three hundred dollars for prosthesis, except that for purposes of the surgical removal of
breasts due to tumors the yearly benefit for prosthesis shall be at least three hundred
dollars for each breast removed.
(c) The coverage required by subsection (a) of this section shall provide benefits
for the reasonable costs of reconstructive surgery on each breast on which a mastectomy
has been performed, and reconstructive surgery on a nondiseased breast to produce a
symmetrical appearance. Such benefits shall be subject to the same terms and conditions
applicable to all other benefits under such policies. For the purposes of this subsection,
reconstructive surgery includes, but is not limited to, augmentation mammoplasty, reduction mammoplasty and mastopexy.
(P.A. 79-327, S. 2; P.A. 86-54; P.A. 87-40; 87-275, S. 2; P.A. 90-243, S. 94; P.A. 97-198, S. 3, 5; P.A. 98-27, S. 17;
P.A. 04-34, S. 1.)
History: P.A. 86-54 clarified the section by limiting its applicability to individual and group medical expense insurance
policies and contract plans, rather than to all individual and group health insurance policies and contract plans; P.A. 87-40 amended Subsec. (c) to increase the minimum coverage requirement for prosthesis from $200 to $300; P.A. 87-275
amended Subsec. (c) to provide that the yearly benefit for prosthesis shall be at least $300 for each breast surgically
removed due to tumors; P.A. 90-243 deleted former Subsec. (a) re group coverages, relettered the remaining Subsecs.,
added references to health care centers, substituted references to health insurance policies for references to medical expense
policies or contracts; Sec. 38-262i transferred to Sec. 38a-504 in 1991; P.A. 97-198 added exception in Subsec. (b) and
added new Subsec. (c) re breast reconstruction after mastectomy, effective July 1, 1997; P.A. 98-27 amended Subsec. (a)
to delete reference to Sec. 38a-469(6); P.A. 04-34 amended Subsec. (a) to substitute "Each" for "Any" and require coverage
for a wig if prescribed for a patient who suffers hair loss as a result of chemotherapy and amended Subsec. (b) to require
a yearly benefit of $350 for a wig.
See Secs. 38a-199 to 38a-209, inclusive, re hospital service corporations.
See Secs. 38a-214 to 38a-225, inclusive, re medical service corporations.
See Sec. 38a-542 for similar provisions re group policies.
See Secs. 38a-595 to 38a-626, inclusive, 38a-631 to 38a-640, inclusive, and 38a-800 re fraternal benefit societies.